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76 A 66 7—CE 817 8/68
APPLICATION FOR PLUMBING PER T
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION ADDRESS 22
JOHN A LAMBIE COUNTY ENGINEER 3 Allelssandro
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
Tem a Cit
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET 1 50 OWNER R. B. Brice
KAIL
BATH TUB 1 50 DRESS 5223 Alessandro
SHOWER 1 5o CITY Tmople City TEL NO
LAVATORY ! 1 50 CONTRACTOR Owen Bros. Plumbing, Inc.
SINK ' 1 50 ADDRESS 426S No. Balclwin Ave,
DISHWASHER 150 CrrY El Monte 91731 TEL NO 443-0078
CLOTHES WASHER 1 50 STATE LIC
LICENSE NO 231741 CLASS C-36
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GROUP ZONE ESSED BY a
I AWN SPRINKLER SYSTEM 2 000 / U
WATER HEATER 1 50 INDUSTRUIL 0
WASTE APPROVAL
U
GAS SYSTEM OUTLETS 1 50 INSPECTION RECORP
OUTLFTS OVER �-
5 PER SYSCEM 30 O O Z
{ M1
P
Plan check fee 25% of abo%e See reverse
PLUMBINC PERMIT ISSUING FI F 8 2 00
l OTAL FFF
APPROVALS DATE IN CTOR 5 SIGNATURE
Plan Cherk 9IIpliC'3nt UNDER SLAB WORK 7du
Name ROUGH PLUMBING
`�dc{iCSS GAS PIPING
GAS VENT
City Tel No HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION �
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF / a
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE D RIBlD SDE NTIAL PROPE FINAL
SIGNATURE �, JACK R ALLEN SUPERVISING MECHANICAL ENG R
OF PERMITTEE
PERMIT VALIDATION cK M O CASH
PLAN CHECK VALIDATION c M O CASH
1 6 9 &4c SEP 29 ' 5 -D 6.50—
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